What is assigned to each CPT and HCPCS level II code under the OPPS to identify the payment for that code?

In the context of the Outpatient Prospective Payment System (OPPS), each Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) level II code is assigned a status indicator. The status indicator is a crucial component within the OPPS as it provides information about how a specific service or procedure will be reimbursed. It indicates whether a code is covered under the OPPS, whether it is payable, and how the payment will be calculated. The status indicator also identifies the type of service, which helps in understanding whether the procedure is subject to a bundled payment or if it's exempt from certain regulations.

Modifiers, place of service codes, and payment adjustments serve different functions in the coding and billing process. Modifiers provide additional context about the service rendered, while place of service codes indicate where the service was performed. Payment adjustments are used to modify the payment amount based on specific criteria but do not inherently provide the payment classification for each code as the status indicator does. Thus, the status indicator is key to understanding the reimbursement structure under the OPPS for each CPT and HCPCS code.